Nurses and carers central to e-health services

Paul De Raeve, Secretary General of the European Federation of Nurses Associations (EFN), and EFN Policy Advisors Alessia Clocchiatti and Silvia Gomez Recio consider the role of nursing and social care professionals in the deployment of e-health services in redesigned healthcare systems…

The financial and economic crisis has led EU member states to make several cuts in the health sector, compromising patient outcomes from a quality and safety perspective. It therefore takes new innovative ways of thinking to re-engineer the healthcare system.

There is evidence that bringing in innovative models of integrated care throughout the EU and scaling-up what already exists is central to making change happen now that austerity has hit hard. Cost-effective, high-quality and safe national healthcare systems are dependent upon policymakers and stakeholders developing and implementing high-quality e-health services. e-Health services are paramount in managing the challenges raised by European society and supporting the way the healthcare system and the nursing and social workforce cares for EU citizens and patients.

In fact, the rapidly ageing population accompanied by an increase of people suffering from long-term conditions, non-communicable diseases (NCD) and chronic diseases forces ‘the traditionalists’ to manage the delivery of patient-centric care more cost-effectively by connecting health and social care in a systematic way. The new way to deliver health services can allow healthcare systems to finally become proactive rather than reactive. Evidence points in the direction that ‘models of integrated health and social care for the elderly can result in improved outcomes, client satisfaction and/or cost savings’.

When appropriately supported with ICT-based solutions, the delivery of innovative healthcare services becomes sustainable and more effective. Specific benefits are reported in areas of prevention and self-management of non-communicable diseases (NCD), facilitating the delivery of healthcare in communities and at home. Furthermore, there is a prominent role for ICT in supporting the reorganisation of health services towards integrated care. In particular, telehealth and telecare are two key ways to deploy ICT-based health and social care services as outlined in the Europe 2020 strategy and Digital Agenda.

The nursing and social care community therefore plays a pivotal role in the uptake of technology to deliver care by the use of the internet, computers, tablets and smartphones. However, roadmaps and guidance to arrive at a particular point are not available yet! Consequently, despite the evidence for the benefits, the barrier for a wider uptake of innovative e-health services is linked to providing added value, which leads to reluctance on the side of the users and beneficiaries. The challenge is that systems today are not able to maximise the benefits of telehealth solutions; therefore, actions are needed to strengthen the evidence and facilitate implementation of successful local initiatives proven to be successful

The evaluation process
 

Evaluation and examination of the cost-effectiveness of employed e-health systems is crucial. Health Technology Assessment models and in particular the Model for the Assessment of Telemedicine (MAST), developed by the MethoTelemed project, are proven to be effective tools ensuring a scientific approach. In these models, the evaluation is seen as a multidisciplinary process that summarises and evaluates information about health, social, economic and ethical issues related to the use of telehealth services in a systematic, unbiased and robust manner.

The evaluation process becomes even more important when talking about patients’ safety and quality of care. The European Directive on Patients’ Rights in Cross-border Healthcare, adopted in 2011, represents a major step forward to improve patients’ rights, safety, cooperation and the use of technology. It is vital to make sure that a set of EU standards in the delivering of e-health services is developed to guide deployment. In this way, the level of deployment of e-health services could become one of the most relevant criteria for excellence, especially concerning patients’ continuity of care and health professionals’ continuous professional development.

As the nursing and social care professions represent a fundamental link between the hospital, the primary care sector and the social services, they have a crucial role in delivering the continuity of care through ICT services. However, with regard to the new responsibilities of the health professionals linked to the introduction of ICT solutions, legislation and regulatory arrangements in most European countries are not adapted to recognise the new forms of healthcare.

According to a 2007 study led by the Royal College of Nursing, in collaboration with Bournemouth University, there are some concerns regarding the deployment of e-health services led by nurses. First of all, there are technical problems linked to the system itself: not all offices have personal computers and those that do are not always connected to the internet; healthcare professionals don’t always have basic knowledge of computer or internet use and moreover, they do not usually know how to interact with patients using internet communication. Concerning nursing in particular, there is a lack of nursing input into the design of new systems. Secondly, there is a fear that these new computerised systems will take nurses away from direct patient care. Another big question is: who is taking the responsibility to defend and ensure their professional interests in healthcare systems strengthened by ICT? Unluckily, there is lack of an effective, independent voice on e-health issues on behalf of nursing.

Necessary skills

If on one side there are still several barriers in the redesigning of healthcare systems, especially with the help of ICT tools, on the other side, some member states have taken a step in the right direction by introducing new concepts as Advanced Nurse Practitioners and Nurse e-Prescribing, which are two examples on how health systems can change with the use of technology. Evidence suggests that the implementation of nurse prescribing is safe and clinically appropriate. e-Prescribing represents a step further, allowing nurses to electronically transmit a new prescription or renewal authorisation to a community or mail-order pharmacy. The good practices indicate that technology itself is useless without a skilled workforce.

In fact, only when properly educated can health professionals lead and support the new societal challenges they face, contributing to the empowerment of patients in the management of their own health and wellbeing. It is therefore necessary to ensure health and social care professionals have the necessary skills, including e-skills, to make optimum use of available health information technology. In this regard, the Commission is calling for a highly skilled and educated workforce in Europe in one of the EU seven flagship initiatives, as it is the agenda for new skills and jobs, part of Europe 2020 Strategy. The rapid development of new technologies has bound nursing and other healthcare disciplines to explore new methods of teaching, for instance introducing e-health education programmes. Nurse educators shall need to adapt to the new system, providing their students the necessary knowledge, skills and competencies to use ICT tools.

Social media is one of new revolutionary subjects that will be in the curricula. In fact, it represents a new way to lead nursing education, to practice research, to gather data and to do interventions. In the United States of America some organisations, such as the National League for Nursing (NLN), are supporting faculties in developing informatics courses for nurses, including new subjects such as blogging or the use of Facebook. Another good example comes from Canada, where the Registered Nurses’ Association of Ontario provided an e-health toolkit for professors to teach these new methods, preparing their students for healthcare demands and challenges.

‘The right knowledge’

Evidence reports that in the US, the number of healthcare services making use of social media grew by 210 per cent between 2009 and 2011. An example of a new application is the ConnectedHealth Nursing Manager Application (NMA), where the nurses can capture data from medical devices and transfer them to the ConnectedHealth Platform, which can be accessed by hospitals and caregivers, providing at the same time a safety mechanism to gather data and the guarantee of the patients’ privacy. According to a study led by the NLN, the nurses should receive education in computer literacy, information literacy and informatics, together with patient privacy and ethics. The development of these new disciplines is running so fast that nursing profession needs to be ready to adapt to the new system.

Next to social media, there is an exponentially increasing use of smartphones to enhance nursing practice. There are not so many studies showing how many nurses use smartphones daily, but there are an increasing number of medical applications linked to this tool. These new ‘apps’ represent a revolutionary way to manage data since they can include drug references, medical calculations, guidelines, etc. Moreover, they can also be very useful in the prevention field.

As the world faces a massive increase in the levels of death and disability resulting from non-communicable diseases (NCDs), there is an urgent need for nurses and social care workers to jointly address this growing threat to global health and development. Statistics now show that 60 per cent of deaths globally are due to non-communicable diseases, with 80 per cent occurring in low and middle-income countries. There is evidence that, with the right knowledge, skills and opportunities, nurses are uniquely placed to act as health coaches and to help prevent NCDs by supporting healthy lifestyles. For this reason, ICT and apps in particular are becoming key instruments to raise awareness, engage and educate the nursing and social care community, allowing them to share information and expertise. Nowadays, there are different applications useful for managing chronic diseases, diet, exercise and lifestyle choices and nursing and carers shall be able in the near future to use these instruments to educate the patient in a new and better way.

In conclusion, the current global economic and societal situation is calling for a deep rethinking and redesigning of the healthcare systems, especially through the deployment of e-health services in nursing and social care. Focusing on fieldworkers and patient’s needs, their empowerment in the system will lead to a cost-effective, sustainable health system with a highly educated and motivated workforce. The deployment of ICT-based telehealth and telecare solutions has enormous potential for nurses and social care workers to remain close to the patients’ needs.